This section of our website is dedicated to supporting Health Plan of San Joaquin providers with valuable tools and resources. Please click here if you are looking for Provider Policies documents.

Forms

 | Size: ##size## Jul 27th, 2020 New Medical Technology & Device Request Form  | Size: ##size## Dec 4th, 2019 PCP Doctor Change Form  | Size: ##size## Dec 2nd, 2019 274 Form for DME Transportation  | Size: ##size## Dec 2nd, 2019 SB137 Transportation/DME Data Validation  | Size: ##size## Nov 11th, 2019 Provider Dispute Resolution Request Form  | Size: ##size## Aug 29th, 2019 Physician Certification Form - Request for Transportation  | Size: ##size## Jun 11th, 2019 HPSJ Prior Authorization List  | Size: ##size## Apr 16th, 2019 SB137 Data Validation Provider Form  | Size: ##size## Apr 16th, 2019 SB137 Data Validation Form Facilities  | Size: ##size## Apr 16th, 2019 274 Form For Provider Practioners  | Size: ##size## Apr 16th, 2019 274 Form For Behavioral Health  | Size: ##size## Apr 16th, 2019 274 Form For Ancillary Facility  | Size: ##size## Mar 27th, 2019 DRE Confidentiality Statement Form  | Size: ##size## Jan 28th, 2019 Change Healthcare EFT-ERA Enroll Online  | Size: ##size## Dec 12th, 2018 Me & My Baby Program  | Size: ##size## Oct 25th, 2018 Synagis Recommendations 2018-2019  | Size: ##size## Oct 25th, 2018 Synagis Authorization Form 18-19  | Size: ##size## Apr 26th, 2018 Offset Request Form  | Size: ##size## Feb 2nd, 2018 Outpatient Palliative Care Referral Form  | Size: ##size## Jan 24th, 2018 Primary Care Physician / Main Doctor Change Form / English - Spanish  | Size: ##size## Nov 2nd, 2017 Medication Prior Authorization Form  | Size: ##size## Nov 2nd, 2017 Disease/Case Management Referral Form  | Size: ##size## Jun 21st, 2016 Diabetes Outpatient Education Referral Form - Doctors Medical Center only  | Size: ##size## Jun 20th, 2016 CHEER Program Referral Form  | Size: ##size## Oct 29th, 2015 UM Appeal Cover Sheet  | Size: ##size## Oct 20th, 2015 Specialist Referral Form  | Size: ##size## Jul 17th, 2015 Western Drug DME Order Form
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Preventive Health Guidelines


Behavioral Health Care Services


Beacon PCP Toolkit


Pharmacy Tools & Resources


Advance Directive Forms

(For Members) A copy of an Advance Directive form can be found below. After a patient/member fills it out, a copy can be given to the doctor and a family member. 


Pediatric Obesity Toolkit

Posted on June 17th, 2015 and last modified on October 29th, 2020.

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